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Disability Insurance - Tremor

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  • Disability Insurance - Tremor

    Hoping to pursue orthopedic surgery, have always had a mild tremor. My dad has the same. Never received an actual diagnosis but have been taking propanalol for it. Will this affect my ability to get disability insurance?

  • #2
    will likely have the tremor excluded, but check with some of the financial/disability salemen here

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    • #3
      almost certainly going to be excluded.

      i would do 2 things:

      a. make sure you disclose this up front to your agent and underwriter, you don't want to be hiding stuff
      b. would also get w/ your school (dean of students?) and make sure that this isn't going to limit your ability to successfully practice. i know someone who start gen surg and then learned that he had some issues w/ binocular vision and couldn't progress, this happened at a relatively advanced PGY level. seriously figure this out, think about spine and hand in particular both of which will be required in residency. don't just think that you will overcome any adversity and get through it based on force of will. many ortho residents barely see the OR until PGY3, you wouldn't want to spend 2 years doing gen surg floor work then carrying the pager only to find out that you have a technical limitation that will prevent you from completing residency.

      also talk w/ your neurologist and your dad, is this going to get worse? you don't want to train and have a carve our in your DI that will just leave you jobless at the age of 45.

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      • #4
        Originally posted by MPMD View Post
        almost certainly going to be excluded.


        b. would also get w/ your school (dean of students?) and make sure that this isn't going to limit your ability to successfully practice. i know someone who start gen surg and then learned that he had some issues w/ binocular vision and couldn't progress, this happened at a relatively advanced PGY level. seriously figure this out, think about spine and hand in particular both of which will be required in residency. don't just think that you will overcome any adversity and get through it based on force of will. many ortho residents barely see the OR until PGY3, you wouldn't want to spend 2 years doing gen surg floor work then carrying the pager only to find out that you have a technical limitation that will prevent you from completing residency.

        also talk w/ your neurologist and your dad, is this going to get worse? you don't want to train and have a carve our in your DI that will just leave you jobless at the age of 45.
        This issue was totally untreatable? Seems crazy to get that far and have it be that terrible.

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        • #5
          You should search and read The Physician Philosopher’s experience with this exact issue.

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          • #6
            Career: Seek guidance at your med school. It may not be the Dean but you will actually receive guidance, testing or evaluation as needed. Likely this will be completely confidential. The points about spine and hand are valid. However, it’s not just limited to those. You need to realize your malpractice and liability may be impacted down the road. Get the cards out on the table.

            ”Never received an actual diagnosis but have been taking propanalol for it.” This is a little confusing. Unless you read your own chart it seems like something is documented.
            I hope you have already done your due diligence. If not, it might come out just fine or with some suggested constraints.

            Scott at MD Financial Services typically chimes in and is sensitive to these situations. DI Insurance- Talk with one of the WCI vendors before doing ANYTHING for DI Insurance. If you get turned down, that may prevent even the guaranteed issue policies. Result is no DI Insurance. You might end up getting a residency guaranteed issued first and then your own. Seek advice.

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            • #7
              Originally posted by Zaphod View Post

              This issue was totally untreatable? Seems crazy to get that far and have it be that terrible.
              subtle eye issues making detailed surgical procedures unsafe.

              i think not as apparent on smaller cases.

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              • #8
                Originally posted by MPMD View Post

                subtle eye issues making detailed surgical procedures unsafe.

                i think not as apparent on smaller cases.
                Yes, I read on it quickly but its apparently treatable? Ofc i have no clue to this persons issue/severity, but man I'd be trying to fix it.

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                • #9
                  Originally posted by Zaphod View Post

                  Yes, I read on it quickly but its apparently treatable? Ofc i have no clue to this persons issue/severity, but man I'd be trying to fix it.
                  i think the more accurate thing to say would be that it CAN be treatable.

                  Comment


                  • #10
                    I don't know what the specific problem this surgical resident had with his vision, but I will say this: I don't have stereovision. Stereovision is the "3-D" part of our vision. It's created by the brain putting together the two slightly different inputs from our two eyes and creating a mental model we "see" in 3-D. It's unique to animals with eyes on the front of their heads, and accounts for approximately 70% of our depth perception. It's also created by the brain wiring itself up properly during the first two years of life -- babies aren't born with stereovision, it has to develop. Which means it can fail. The most common cause of failure is babies who are born with moderate to severe strabismus (cross-eye or "lazy eye") that isn't corrected surgically within two years of life. For some reason, the fact that the input from one eye isn't where the brain "expects" it to be means that the stereovision wiring never gets hooked up correctly. The result is that the brain shuts off in the input from the macula from one eye so you, weirdly, get focused vision from only one eye at a time but peripheral vision from both eyes. You can see just fine, but you lack the ability to see "in 3-D" like most people have.

                    I had very bad strabismus as a child that was corrected with prisms during my elementary school years, so my brain never wired up the stereovision module. The best way I can describe my vision is that for most of you, there is an indescribable but fundamental difference between a (not 3-D) movie and the real world. For me, there is no difference. The real world has the exact same amount of depth that a typical movie has. For me, 3-D movies are unwatchable; they're blurry and give me a migraine. Do you guys remember the stereograms that were all the rage in the late 90s? Where you defocused your eyes and suddenly an image would pop out of the mess of colors? I can't see them. How about the toys we had as children where you looked in a weird pair of binoculars and the little dinosaur drawings were in 3-D? Also don't work for me. I find all of this super weird, because I can see the real world just fine, and it is manifestly in 3-D, so how am I not seeing in 3-D? But there is this entire world of depth perception that my brain simply isn't set up to interpret.

                    All of this is to say, I have a limitation in my vision, it is not fixable, and I went into med school knowing that going into surgery was not an option for me. My lack of stereovision actually makes laparoscopic surgeries easier, because again, looking at the camera screen isn't fundamentally different from looking at the real world. I have always lacked 70% of my potential depth perception, but that means I'm used to using the remaining 30% to judge distances far more than the rest of you, so I'm better at it. But in every other kind of surgery, I am at a severe disadvantage. I simply cannot judge distances well enough. As a med student, I once got kicked out of a surgery because I kept moving my head to get different angles on the sutures I was supposed to be cutting, and I got in the surgeon's way. I, at least, had less than no desire to go into surgery in the first place, and I also was aware that I don't have stereovision, so I knew what was wrong and the difference it would make. But someone who didn't know they lacked stereovision, really wanted to go into surgery, and didn't have enough experience being the actual person doing the surgery? Could absolutely make it pretty far into surgery residency before it became obvious that the lack of stereovision was a career killer.

                    Again, I don't know if this is exactly the issue the resident in question faced, but it's certainly possible. And it's not fixable.

                    Comment


                    • #11
                      Originally posted by whispuringeye View Post
                      Hoping to pursue orthopedic surgery, have always had a mild tremor. My dad has the same. Never received an actual diagnosis but have been taking propanalol for it. Will this affect my ability to get disability insurance?
                      OP, I’m sorry to hear about your situation. Both my father and I have tremors, his being much worse than mine. I was diagnosed with a “mild tremor” by my neurologist and started on very low-dose propranolol bid. The meds control the tremor relatively well and although surgeons on my rotation did notice the shakiness I still was able to suture and tie knots faster than most of my colleagues and even many of the surgery interns. Definitely tons of room to go up on the dose too if the tremor worsens over time.

                      I did consider pursuing plastics and ortho as I had the grades, but ultimately decided against going into a field where I may not be able to effectively perform my job duties in 10-20 years. I do know that if that happened later on you could transition to consulting/administrative work but didn’t want to have to always worry about a back up plan. Definitely thought about this a lot as an M1/2 and felt pretty discouraged. Ultimately I decided on dermatology which is obviously still procedural but by no means has the same expectations of a surgeon.

                      ditto on the physician philosopher. He has a tremor and works in regional anesthesia which requires pretty significant precision. According to his recommendation, don’t apply for DI until you get your guaranteed residency hospital policy. I’m about to start residency and waiting to secure both my prelim then my advanced position’s disability policies before attempting to secure an individual plan.

                      Comment


                      • #12
                        Originally posted by whispuringeye View Post
                        Hoping to pursue orthopedic surgery, have always had a mild tremor. My dad has the same. Never received an actual diagnosis but have been taking propanalol for it. Will this affect my ability to get disability insurance?
                        Most likely will have a negative impact to the disability plan. Depending on where you are going to do your training they may have a GSI (guaranteed standard issue) disability policy there. The issue with those is the rates sometimes can be higher (due to gender blending) and if you have EVER been declined, postponed or modified then that is off the table. What program are you going to?
                        Scott Nelson-Archer, CLU, ChFC
                        281-770-8080 Direct / [email protected]

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                        • #13
                          I also took a low dose propranolol when operating in residency and it didn’t affect my DI cost. They told me I got the “preferred” rate and they knew about the beta blocker and I told them why I was taking it. I went with Guardian. And I’m an ophthalmologist, where I would think a tremor would be a bigger deal than in most subspecialties of ortho.

                          I may have gotten lucky. I think they listed the reason for the beta blocker as “performance enhancement” or something. It’s been 10 years since I got my DI. In retrospect, instead of prescribing myself propranolol, I should have just done what other Ophthos do and just squirt a couple drops of timolol eye drops under the tongue before operating.

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                          • #14
                            I started on a beta blocker for borderline hypertension when I was a general surgery resident in the 70s. It completely eliminated my tremor as a side effect. Never had issues with micro- surgical techniques later in plastics. Still take it with diuretic at 65.
                            I often felt sympathy for surgeons that I worked with that had tremors, but they usually did great. After all, in ortho, you just need to control a hammer and saw.

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                            • #15
                              Originally posted by Auric goldfinger View Post
                              After all, in ortho, you just need to control a hammer and saw.
                              Don't forget the drill

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